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Tips and tricks for a successful Emergency Department visit

In the last post we discussed why Migraineurs are often mis-labeled as DRUG SEEKERS.

Because a Migraine diagnosis is often used as a means for true drug seekers to obtain prescription medications, emergency physicians are often quite gun-shy about treating any chronic pain patients, including and especially Migraineurs.

They are often not well-versed themselves about appropriate Migraine diagnosis or treatment options such as abortives, and assume patients have entered their emergency department looking only for pain medication.

Additionally, true pain patients and Migraineurs are also gun-shy, often assuming that unless they overstate their pain it won’t be appropriately treated.

Having to admit defeat to our Migraine and landing in the emergency department (ED) is a scary enough proposition, but add to that the pain and helplessness Migraineurs often feel when they’ve become this desperate, combined with physician distrust (some of it earned), and we can end up with quite a disastrous result.

As Migraineurs, it is vital that we are taken seriously and believed when we visit the emergency room (ER). There are effective ways to accomplish this, and things that we can do to really hurt ourselves without realizing it.

Over the years I’ve developed some helpful strategies for emergency room visits:

  • The ER is only for times when you can’t get to your regular doctor, or you need additional abortive treatment that is not available elsewhere. Do go to the ER if you are having the “worst headache of your life” or have symptoms resembling stroke or other life threatening emergency medical condition. If you are in the ED waiting room playing video games or talking animatedly with a friend, you will not (and should not) be taken seriously.
  • Make sure you are seeing a local headache specialist. When ED staff know this, they are often more likely to treat you appropriately and effectively.
  • Take someone with you to act as your advocate. They can speak for you when you are unable to speak for yourself. ED staff are much less likely to treat you negatively when there is someone else in the room.
  • Ask your physician for an emergency room prescription for Migraine abortive treatment, followed only then by pain treatment should you need to visit the ED. You can carry this with you to the ED and most often doctors will follow the suggested protocol.
  • Do not overstate your pain level, but express yourself in easy to understand terms such as “I’ve never ever had a Migraine this bad before. It’s a 10”
  • Upon speaking with the ED staff, make sure they understand that you want a Migraine abortive, not just pain medication. Be educated in your abortive choices (they may not be) so if they ask you what you want to try, you can give them a knowledgeable answer.
  • Dress the part. If you look like a drug seeker when you walk in the door, you will most likely be perceived as one. Makeup is not necessary, and nobody cares if your hair is a mess or your breath is smelly, but at least be clean and wear clean and modest, colored (not black) clothing. Unfortunately, tattoos and body piercings are often disrespected in this setting, so if you’ve got them, try to cover or remove them. Be sure your advocate is at least similarly presented.
  • Treat ED staff with respect. Saying Please and Thank You can go a long way.
  • Expect respect, but understand that fighting and acting hysterical will only hurt you with an already distrusting physician.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • dado
    1 year ago

    I recently had several different experiences at ERS, one easy and pleasant. The doctor recognized my discomfort acknowledged my chronic migraines and asked me what had worked previously. Toradol and phenergran it was administered. Considering Toradol is not a controlled substance should not be an issue. The next experience was the opposite. They had decided to do an infusion for string of migraines that could not be broken. I warn anybody do not allow them to give you Compazine. I thought I was going to lose my mind. For the most part I have found ERs to be Helpful. The drugs I’m seeking have no high!

  • Miryenne
    7 years ago

    I keep reading the post suggesting phenergan. A combination of abortive (or toridol) + phenergan usually is he only thing that works for me when I’ve got a horrendous one. However, lately I have found that most ED physicians (and also my neurologist) will not give or prescribe phenergan anymore as they say it can be abused and there are newer, better, meds out now. As they suggested, I have tried other anti-nausea meds, but I have found that either they don’t work or they have made my nausea worse. Anyone else having this issue?

    and yes – I NEVER go to ER unless I feel that I am dying. I always get treated poorly, even though my husband always goes with me to be my advocate. We both have colorful hair so I feel we automatically get stereo-typed. Luckily, I’ve managed to go only twice (the last time my symptoms were so severe I left in an ambulance from my physician’s office – AND the ambulance medics and ED staff still treated me like dirt – my physician called the ambulance from their office for goodness’ sake!). All I wanted was relief, NOT pain meds…I could not help it if I was agitated, nervous or incoherent from pain at that point – that why I was at the dr’s in the first place!

    I cannot wait until there is an accurate way to analyze pain. I have heard that there has a been recent break through on that with MRI imaging. I can’t wait for the day when all dr’s are equipped with something – so that we can tell them to look IN our head to find out that it is NOT “all in our head” :-).

  • jimhagen
    7 years ago

    It also may be helpful if you can go to a university hospital that your headache specialist practices at… with the anticipation that you will be admitted and that your dr. can help negotiate that for you. We have spoken to my doctor about this possibility. My personal policy is that as long as I believe I am not going to die from my pain… I will “ride it out” until I can see a physician.

  • jimhagen
    7 years ago

    Being new to this forum I would like to say thank you. Many times individuals with headaches need to write or verbalize their state.
    There is one thing I read in a blog on this site which I disagree with… It was stated that if you are the ER talking animatedly with a friend you have no reason to be there.
    I think as a long time sufferer of headaches… 6 and a half years of excruciating daily chronic headaches… that you cannot always tell how much someone is suffering by appearances. I will often “hold up” the pain when I am in a social situation. Also… someone may be in the euphoric state of the migraine process… And they may know that in an hour or two they are going feel like they are in Hell… I personally avoid the ER at all cost but I would never, ever, not ever tell a fellow headache sufferer they have no business being in the ER…
    Also, I think you need to form your own policy as to how you will look when you go to the ER or your doctor. I have found that it makes no difference for me personally although I tend to have good bathing habits… My dignity has been slapped around enough… no one is going to tell me how to dress or look when I see my doctor. Now some people may find this advice helpful but I know of many people who look like church mouses who have been labeled as seekers. My advice is to look everyone who you deal with in the eye. If they don’t look you in the eye try to engage them. Much of the advice is about training yourself to adjust to “their” system. It also helps if you can quote the hospital’s policy to them if they start to violate said policy. You can also ask to speak the head nurse if you feel you have not been treated properly.

  • Kait Jackson
    7 years ago

    I had to go to the ER the week before my first neurologist appointment. My headache that day started as stiffness/pain in my neck and shoulders, and was absolutely the worst pain I’d ever felt. I had tried a muscle relaxer earlier in the evening, and it worked for a grand total of an hour before the pain came rushing back. I made it through cooking and eating dinner with my boyfriend, and we were in the ER by 10:30 that night. After putting me in the pediatric ward of the department (because of my short stature, I fit on the beds there, I guess that’s why they put me there) I talked to a nurse and a doctor, told them I was currently in treatment for migraines but didn’t have any medication prescribed yet. I hurt too badly to notice if they were nice or suspicious or whatever, but they had me do a urine test before giving me medication. At the time I thought they were just doing a pregnancy test, but my boyfriend later informed me they were doing a drug test. I’m glad I didn’t realize it at the time, because now it kind of hurts my feelings. I mean I understand why they do it… but wow, way to make me feel like I’m doing something wrong by seeking help!

  • Holly Scott
    7 years ago

    I just experienced my first ER visit due to a migraine at work that crippled me. I was pumped full of anti nausea and pain meds. Although my pain was gone I experienced head pain a few days later and it was consistent for pain for 4 days. When I went to visit my regular doctor she told me that she too suffered from migraines and sometimes pain meds can trigger a a migraine. Now I have the right tools to deal with it and hopefully won’t suffer like that again.

  • Shelley McCulley
    7 years ago

    Ugh, I’ve dealt with “skull-splitters” for years! I’m so sorry you had to go through that pain. It is like no other! Love you.

  • Megan McGee
    7 years ago

    My er recently told me they are going to refuse treatment on me because they don’t specialize in migraines. Yes this I understand but when I can’t see and my head is hurting so bad I can’t get in to my dr and its been a couple days of this. Im going to the er. It’s sad how we get treated and I so badly want to print everything off here and show that jerk that told me that. I am not making this up I would love to be happy for just one week of my life with no migraine

  • Jenney Miller
    8 years ago

    My ED does not use narcotics as protocol (in general-in fact, they have to have a neurologist order the narcotics if nothing else works. Because my preventative is in pill form, I tend to have to go to the ED a lot because I have severe nausea and dehydration with most of my migraines. My doctor is affiliated with my ED fortunately, and they will call her if the standard protocol is not working-there are times it does, but my migraines have been changing so there are a lot of times it doesn’t. (I am 42 and mine are increasing in intensity, length, and pain) As a matter of fact, this hospital (at one time) had a headache clinic and that is where I was diagnosed at 14 with migraines and cluster headaches. I think this article is right-if you are complaining of “the worst headache of your life” and you are loud, playing games or whatever on your phone, the perception is there no matter what is really going on. I always have someone with me, as there are times the pain is bad enough that I don’t even want to hear the sound of my own voice, and they can let the doctors know how long I have been fighting with the migraine, if I threw up medication, etc.

  • Heather Reed
    8 years ago

    I have found that a combination of torridal compazine and decadron iv and then a tapered dose of a decadron pills have helped my migraines. I try to avoid the ER and hospital after multiple bad experiences do being admited for a migraine and ended up being overmedicated. I have my doctor prescribe zofran I’m shots for when I’m throwing up and unable to keep things down, I also take sumavel dose pro shots and prescription pain medication. I also work in the ER and one of the biggest things from looking at patients that claim to have a migraine, often do not see a neurologist or are on medication to prevent migraine attacks or treat migraine attacks.

  • Shirley Hebert Ulbrich
    8 years ago

    Wow, wish I knew this before 11/25! Ended up going to ER, 11-6pm w/3 hrs waiting! Finally gave me: Relpax (new), 2 bags fluid (severely dehydrated due to nausea/vomiting 3 days straight), and 2 shots (guessing 1 potassium). It’s now 12/9 @ 7pm & continue to have head pain (scale: 4-8). Having symptoms of serotonin syndrome; had EKG & labs last night. Virtually every single dr is hesitant to treat me. They sent me away after a “normal rythem” & told me to make appt w/migraine clinic; got referral 11/30. Great! My heart is racing, tachy, sleep deprived, wake to night terrors. Can’t eat, nausea,… Every symptom except death, lol! Even my pain dr not able to help (have pain contract w/him, recovering from surgery). Just took OTC migraine, potassium & alpha lipoic acid. What to do? I am blessed w/great support.

  • Dara Alexander Walker
    8 years ago

    YIKES!! Sounds horrible! I hope you can find something that will work!!

  • Zac David Szoke
    8 years ago

    I rarely get migraines and have only been to the ER for one once, but am a chronic Cluster Headache sufferer which has led to me having to be in there many times because of the absolute intensity of clusters despite being on preventatives and proper abortives. (Not to say it’s any better being a Migreuner, at all.) Many of the standard treatments in an ER setting are largely the same… for a long while they tried to give me either DHE or the toridol/benadryl/compazine combination, though they don’t help my headaches when they’re bad enough to go to the ER. If you ARE someone who does not respond well to the more standard treatments and ultimately need narcotics in an ER situation, as I am (though they are a last resort and in general, most will find other treatment that is frankly more helpful), my advice is to understand that sometimes you have to let a doctor try a treatment you know won’t work if only so they will see it does not, rather than tell them up front not to bother. You are welcome, and should tell a doctor if a certain treatment “has not worked in the past,” or something similar, but a willingness to try again or try something first before pain medication goes a long way. Carrying your doctor’s card, or at least telephone number, is always a good idea, especially if your neurologist has no ties to the local ER and you forget your prescription for ER treatment, if you have one. It can be quite hard to keep your cool when your pain (or other symptoms, in the case of Migraneurs) gets way up there, as chances are it is.

  • Zac David Szoke
    8 years ago

    Sorry! I forgot to actually finish that post. Despite it being sometimes difficult to be polite when you feel as though you are not being taken seriously for a ver real condition, it is absolutely true that a little politeness goes a long way. While it is true many ER doctors do thrive on excitement, it is also true that all doctors want to feel like they made a difference, ultimately. It’s a much more visceral “difference” when it’s a matter of life and death, but I’ve never met a doctor who didn’t appreciate politeness. And in fact, just by being polite, you will be seen as less of a drug seeker. Thank them for trying to help in any way they can, and once (or sadly, IF) your headache is feeling better, be sure to thank them for making it so.

  • Marquita Fuchs
    8 years ago

    yes the er is a very difficulty place to seek care. The staff is used to drug abusers.
    explaining your history and what you have utilized in the past. Narcs are a last resort.
    Phenergan and fluids.

  • Ellen Schnakenberg
    8 years ago

    It’s really important to realize that the best thing an ER can do for you is to act to abort the Migraine process and give you needed fluids, etc. Yes, pain relief is an important part of this equation, but if you address stopping the attack with more fervor than getting pain relief (which many doctors unfortunately scoff at) you are likely to have a better outcome.

  • Louise M. Houle
    8 years ago

    Things that have worked for me and others in our support group here in Montreal… (Our health care system is different, and ER visits are covered, but I’ve heard similar stories.) When I present to the triage nurse, I state that I have a known diagnosis of chronic migraine, and that I am followed by a migraine specialist/neurologist, and I give his name. I also go to the ER where my General Practicioner works and give her name as well. My file is in the system. I explain that I rarely present to the ER, only if I’m dehydrated from vomiting, the pain is the worst ever, or if after 24 hours my usual meds do not bring the high pain level down and I can’t take it anymore. Fortunately, I usually don’t have to wait long to be admitted. Once I see the doctor, I explain what I have taken so far and at what time, and state what worked last time I was at the ER. Fortunately, doctors keep me there until something works. Almost always starts with DHE & an anti-nausea; then an anti-inflammatory, then the pain killers if still needed. Good luck everyone!

  • Jamie
    8 years ago

    If my current treatment from my headache specialist is a narcotic (Demerol), what would you suggest saying at the ER? Even if I’m in severe pain, and my meds haven’t helped at all… I hesitate to even consider going to the ER because I feel like I’ve already taken what they’d try there. I think I’ve actually had a little luck with Toradol, but I have horrible panic attacks when my husband (or I) tries to give them to me at home (needle-phobia).

  • Holly Harding Baddour
    8 years ago

    there are many meds besides narcotics that are effective for migraines- I find that suggesting these cocktails proactively to the ED docs helps them know I am not drug seeking (magnesium, benedryl drips, toradol, phenergan for instance). letting them know that I am open and in fact prefer to try these first helps them know I am a real migraine patient.

  • Becky Williamson
    8 years ago

    We have experienced terrible treatment in the ER before too. Some Drs. have been great but there are two that are awful. One offered nothing but Tylenol. The other pretty much told lher she was a drug seeker and he was not giving her anything but Toradol and when she told him that does nothing for her migraines he said he didn’t have anything more to give. We left with no treatment at all. It is a constant battle.

  • Melody Wiles Watson
    8 years ago

    I just think that really sucks!! Dr. are suppose to help not turn away.

  • Jen T
    8 years ago

    Thank you, Ellen, for this informative article. I have been getting migraines now for about 20 years. I’ve had some really bad migraines over the years, but I haven’t gone to the ER for several reasons. Mainly, the thought of having to tolerate the ER waiting room environment: bright lights, noises, and limited access to a restroom. I would need to have a barf bag beside me! It would be an agonizing wait, especially if ER staff isn’t taking you too seriously. I would only go if it was “the worst headache of my life”, or if I thought I was having a stroke. I hope I never have to go to the ER for an extreme migraine, but if I do, the tips you provided will be very helpful. It is unfortunate that there are dishonest people out there who ruin it for those of us who truly are suffering from pain, and need treatment.

  • cindilou3
    2 years ago

    Sometimes all me abortives have failed and I am dehydrated, vomiting, haven’t slept know from 14+ years of chronic migraines and many treatments that it is not going to go away without IV therapy. I do not prefer narcotic, especially morphine ( triggers rebounds) but sometimes I do get nubaine with thordol and chompuzine. ( probably spelled wrong.But I will take anything that works and don’t want narcotics to often due to past addiction problem) The ER doctors here can be nice or not depending on the Dr.. They are alot nicer then they were 14 years ago. It does help when my husband gets assertive! It also helps when you let them know that you have educated yourself about your migraine care. I’ve found sometimes I know more then the ER Dr.s and nurses! and sometimes the teach me something new. Our Er does a FASTTRACK for people with no serious symptoms and you see a nurse practioner. I like this cause it’s very fast but they don’t really check you and they rush and don’t listen to what you do works for you and what doesn’t. If I have to see a Dr. on a weekday evening everybody in small town from a stubbed toe to a bumped head is in the ER on their cell and the few of us who really need to be there are vomiting in the lobby in bags or bleeding everywhere and we have to wait for hours. I’m not trying to judge because we never really know what others are going through but when you can hear them talking loudly on their cell like their at home relaxing it kinda seem like they could have waited to go to the dr. It’s funny cause on friday and saturday evenings it’s not so crowded. Ha. Anyway a comment on how your dressed. By the time I decide to go to the ER I have been up for days, it hurt to put on my clothes and go into another room so I slip on my flip flops no matter how cold, I don’t wear a jacket cause I’m always hot but I do somehow manage to run a brush through my hair. I really don’t care what the ER staff thinks about the way I look because at that point I could care less. If they are disrespectful to me my husband calls the hospital administration office and complains and this has made a difference. I think one reason they don’t usually treat me like a drug seeker is like I said before, I know ALOT about migraines and i don’t ever ask for narcotics and I don’t go often. I hope the ER staff in most hospitals these days have learned by now how to tell the difference between people who have a migraine and drug seekers but there are hospital staff who are just there to get people in and out as fast as they can. or they don’t really care. Sometimes I cry cause I’m afraid I’m going to get one the staff members with an attitude and my trip will be in fain. But what I do if my migraine hasn’t improved in about 8 8 hours I go back. They’ve learned they need to go ahead and treat me first time and we never have to be rude, just assertive! Sorry so long. Just wanted to get my experience out there.

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